A 64-year-old man is being managed in hospital for a hematologic condition. During the course of his chemotherapy, he develops bleeding from IV lines. A blood smear is shown.

Which of the following is most likely to be seen in this patient?

A) Decreased fibrinogen
B) Decreased fibrin degradation products
C) Decreased plasmin activity
D) Decreased prothrombin time
E) Increased plasminogen

A 12-year-old girl is brought to the physician for a follow-up appointment. She has had no recent illnesses. Vitals are normal. Her had a history of “anemia” that was treated with splenectomy in early adulthood. A blood smear is shown.

If left untreated, this patient is at greatest risk for developing which of the following?

A) Cholelithiasis
B) Coombs test positivity
C) Disseminated intravascular coagulation
D) Microangiopathic hemolytic anemia
E) Normal ferritin with decreased serum iron

A 63-year-old man comes to the physician for a follow-up appointment. He has had intermittent headache for the past two months and occasional blurry vision. For the past week he has had increased diffuse bodily itching following his nightly shower. Laboratory studies show:

Hemoglobin                                    18.0 g/dL
Leukocytes                                      14,000/μL
Platelets                                            300,000/μL
Serum calcium                               9.0 mg/dL

Which of the following is most likely to be seen in this patient?

A) Decreased erythropoietin
B) Kappa light chain IgM spike
C) Lambda light chain IgG spike
D) Nephrotic syndrome
E) Serum basophils of 1.0%

A 32-year-old woman comes to the physician for a routine health maintenance examination. MCV is 72 fL. Serum iron and ferritin are within reference range. Which of the following is most likely to be seen in this patient?

A) Decreased HbF
B) Decreased porphobilinogen deaminase
C) Helmet cells
D) Increased HbA2
E) Pappenheimer bodies

A 15-year-old boy is brought to the physician by his parents for a follow-up examination. His laboratory studies are shown:

Bleeding time                                                        8 minutes
Prothrombin time                                              14 seconds
Partial thromboplastin time                        48 seconds
Platelet count                                                       220,000/μL

Which of the following is the most likely explanation for this patient’s findings?

A) Antibodies against glycoproteins IIb/IIIa
B) Defective glycoprotein IIb/IIIa
C) Deficiency of clotting factor
D) Reduced bridging of glycoprotein Ib to endothelium
E) Reduced cofactor for gamma-glutamyl carboxylase

A 30-year-old man comes is evaluated in hospital. His father has a history of cirrhosis. His arterial bloods are shown:

pH                                             7.39
HCO3^–                                    24 mEq/L
O2 content                          Reduced
pO2                                         90 mmHg
pCO2                                      38 mmHg

Which of the following is the most likely explanation for this patient’s findings?

A) Alpha-1 antitrypsin deficiency
B) Anemia
C) Polycythemia vera
D) Salicylate poisoning
E) Ventilation/perfusion mismatch

A 34-year-old woman is evaluated in hospital. She has no past medical history. Vitals are stable.

Which of the following is most likely to be seen in this patient?

A) Creatinine of 1.0 mg/dL
B) Fibrinogen of 80 mg/dL
C) Hemoglobin of 18.5 g/dL
D) Holosystolic murmur at lower left sternal border
E) Platelets of 560,000/μL

A 9-year-old girl is brought to the physician by her mother for a 3-day history of small red spots on her shoulders and chest. She has no past medical history apart from a viral infection a couple weeks ago. Hemoglobin is 14 g/dL. Prothrombin time is 12 seconds. Partial thromboplastin time is 34 seconds. Bleeding time is 9 minutes. Leukocytes are 8,000/μL. Glucose is 88 mg/dL fasting. Which of the following is most immunologically similar to this patient’s condition?

A) Arthus reaction
B) Graves disease
C) Malar rash
D) Rhus dermatitis
E) Urticaria

A 14-year-old boy is brought to the physician with scleral icterus for the past 2 days.

Which of the following is most likely to be seen in this patient?

A) Dacrocytosis
B) Decreased glucose-6-phosphate
C) Decreased NADH production
D) Increased disulfide bonds
E) Reductive environment

A 31-year-old woman comes to the physician for a 3-day history of mildly productive cough and fever. Physical examination shows a right lower lobe consolidation with dullness to percussion. She has lymphadenopathy of the head and neck. A peripheral smear is shown.

Which of the following is the most likely explanation for these findings?

A) Chronic lymphocytic leukemia
B) Chronic myelogenous leukemia
C) Cyanocobalamin deficiency
D) Jarisch-Herxheimer reaction
E) Leukemoid reaction